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Biomedical subjects

W Klepetko

Publications and source records attributed to W Klepetko.

161 records · Page 9Linked to original sources
PubMed1987

[Risk factors for morbidity and mortality in resection of cancer of the cardia].

Operations were performed on 166 patients for adenocarcinoma of the cardia, between 1970 and 1986, with resections being applied to 102 of them (6.1 per cent), including 87 curative approaches with complete removal of tumours and no macroscopic evidence of metastases. Total gastrectomy with oesophagectomy was performed on 36 patients and proximal oesophagogastrectomy on 66, in 43 of these via left thoracic incision. Regional lymph nodes were free of tumour in 29 patients (28 per cent). The other approaches to proximal resection were thoracoabdominal in eight cases, abdominal in 13, and transmediastinal in two. Leakage of oesophageal anastomosis occurred in 19 cases and was followed by septicaemia and death in 13. Overall mortality during hospitalisation amounted to 22.5 per cent, including two patients who died on the 30th postoperative day as a result of dehiscence and septicaemia. Mortality figures were 17 per cent following total gastrectomy and 19 per cent in the wake of proximal gastrectomy by thoracic incision. Mortality amounted to 48 per cent in the 23 cases on which abdominal, thoraco-abdominal, and transmediastinal operations had been performed. Multiple logistic regression was used to determine age, ECG, spread of lymph nodes, and surgical techniques as potential risk factors. Emphasis in the context of surgical techniques was laid on proximal versus total gastrectomy, incision on both sides of the diaphragm, palliative resection, and anastomotic suturing (using one-layer or two-layer techniques or mechanical staples). Tumour spread to lymph nodes and proximal resection were the only independent variables associated with dehiscence. Electrocardiogram (ECG), lymph node involvement, and palliative resection proved to be of relevance to prognostication of lethality. No statistical correlations were found to exist between lethality, on the one hand, and surgical approach, age of patient, incision on either side of the diaphragm or suturing, on the other. The conclusion was drawn that in cases of cardia carcinoma total gastrectomy does not aggravate the risk of lethality, as compared to cardia resection.

Adenocarcinoma↗
PubMed1985

Risk factors for severe bacterial infections after valve replacement and aortocoronary bypass operations: analysis of 246 cases by logistic regression.

Risk factors for severe bacterial infections, that is, deep sternal wound infection, pneumonia, septicemia, and prosthetic valve endocarditis, were evaluated in 246 consecutive patients undergoing valve replacement (N = 84) or aortocoronary bypass operation (N = 162). Multiple logistic regression analysis was applied to determine the ability of putative risk factors to predict infection. The risk factors considered were age, sex, diabetes mellitus, duration of cardiopulmonary bypass (CPB), duration of operation, amount of blood restored on the day of operation, repeat thoracotomy for bleeding, intraaortic balloon pumping, reoperation, emergency operation, and the professional status of the surgeon. Severe infections occurred in similar frequency after valve replacement (8/84; 9.5%) and aortocoronary bypass (11/162; 6.8%). For patients who had a bypass procedure, repeat thoracotomy was the only factor significantly associated with infection (p = 0.0004). However, the classification analysis revealed that this variable alone is too unspecific for a reliable prediction. Univariate analysis indicated that restoration of more than 2,500 ml of blood (p = 0.0001), reoperation (p = 0.0821), duration of operation (p = 0.0061), duration of CPB (p = 0.0318), and intraaortic balloon pumping (p = 0.0281) were associated with infection following valve replacement. A model with three variables emerged from the multiple logistic regression: after correction for blood restoration, reoperation, and duration of CPB, no other variable was of additional predictive value. For patients who underwent valve replacement, the model performed well in predicting complications. The classification analysis revealed a high correspondence between observed and predicted instances of infection: it correctly predicted 75% of the patients with infection and 96% of those without infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Plasma fibronectin, albumin, IgM and total protein during cardiopulmonary bypass.

Plasma concentrations of fibronectin, albumin, total protein and IgM were measured in 14 male patients undergoing aorto-coronary bypass operations. Fibronectin and IgM concentrations fell to 55% of the preoperative values 5 minutes after start of the extracorporeal circulation, and the same percentages were encountered 5 minutes after the termination of bypass. The concentrations had recovered to 75% of the preoperative values by the end of the operation. The plasma concentration of albumin was 68 +/- 9% of the preoperative value after 5 minutes of bypass, 66 +/- 7% at the end of bypass, and 83 +/- 9% of the end of operation (significantly different from fibronectin and IgM, p less than 0.05; Wilcoxon's test for paired differences). No correlation was found between the duration of extracorporeal circulation and the post-bypass concentrations of any protein (Kendall correlation). It is concluded that the fall of fibronectin concentrations during cardiopulmonary bypass can be sufficiently explained by dilution, and that a specific consumption of fibronectin does not occur. The less marked decreases of albumin and total protein were probably due to infusion of plasma-protein solution, which is poor in fibronectin and IgM.

Adult↗
PubMed1985

Two years' experience with the duromedics bileaflet heart valve prosthesis.

The new Duromedics Bileaflet Cardiac Valve prosthesis has a special moving hinge mechanism for its two leaflets to wash the critical articulation area and thus reduce thrombus formation. Between October 1983 and June 1985, we implanted 278 of these prostheses in 254 patients. We did 114 aortic valve replacements, 109 mitral valve replacements, 34 double valve replacements, and two tricuspid valve replacements. Nearly 20% of the patients had had previous cardiac procedures. The hospital mortality was 5.9%. Follow-up was started with 214 surviving Austrian patients, and up to the present time, we have a follow-up period of 1704 patient months. Five patients died late after the operation (3.5 per 100 patient years). We observed 10 valve-related complications in nine patients (7 per 100 patient years). There were three cases of prosthetic endocarditis (2.1 per 100 patient years), two paravalvular leaks, and four bleeding episodes (2.8 per 100 patient years). The mechanical hemolysis was minimal, and the postoperative hemoglobin value averaged 15 g%. The LDH increased from 230 IU to 307 in the aortic valve replacements, 406 in the mitral valve replacements, and 435 in the double valve replacements. Intraoperative pressure gradients and postoperative Doppler echocardiography showed good hemodynamic performance. We conclude that good clinical results and a low complication rate can be achieved with the Duromedics Valve.

Journal Article↗
PubMed1985

Functional tricuspid insufficiency: conservative or operative management.

Between 1978 and 1982 mitral valve replacement was performed in a total of 43 patients with mitral valve disease in the presence of functional tricuspid insufficiency (TI). The concomitant tricuspid valve regurgitation was treated conservatively in 17 patients, a Carpentier ring prosthesis was implanted in 9 patients. De Vega annuloplasty was performed in 13 patients and 4 times the valve was replaced with a Hancock bioprosthesis. The hospital mortality of 26% (11 patients) was high, due to the poor clinical condition of the patients. In a mean follow-up of 43.1 +/- 18,0 months, 20 patients could be restudied by clinical and echocardiographical investigation. Tricuspid insufficiency was found in all of the 9 patients who had been treated conservatively. Seven out of 11 patients operated showed no signs of TI, 3 had mild TI and 1 patient had severe TI. In the conservatively treated group, the preoperative mean pulmonary vascular resistance (PVR = 296 +/- 161 dynes x sex x cm-5), pulmonary artery pressure (PAP = 46.1 +/- 16.2 mmHg) and rise of right atrial V-wave (15.8 +/- 3.6 mmHg) were only slightly higher than n the operatively treated group (PVR - 274 +/- 146 dynes x sex x cm-5), PAP = 43.2 +/- 13.6 mmHg, V-wave = 18.5 +/- 6.4 mmHg) with no statistically significant difference. Preoperative hemodynamic findings in patients with and without TI a follow-up were also not significantly different. These results indicate that the recurrence of functional TI depends on the method of treatment, rather than preoperative increased PVR, PAP or V-wave rise.

Bioprosthesis↗
PubMed1984

[The problem of scars in heart surgery with special reference to the use of static magnetic fields].

An attempt is made to survey the pathophysiology of wound healing, as well as the aetiological factors involved and the possibilities of therapeutic intervention to prevent the formation of hypertrophic scars and keloid after cardiac operations. Several prophylactic measures are discussed, with special reference to the use of static magnetic fields. Their application to scars after cardiac operations was carried out by energy pak foils. Patients treated with these foils showed slightly improved results as compared with a control group. The results, however, were not statistically significant.

Adult↗
PubMed1984

[Perioperative cefamandole prevention in aortocoronary bypass operations: the course of serum levels in extracorporeal circulation].

Antibiotic prophylaxis with 2 g Cefamandole at induction of anaesthesia was performed in 12 male patients undergoing aortocoronary bypass surgery. Caused by hemodilution, there was a marked decrease of serum concentration at the beginning of extracorporeal circulation, from 110.96 +/- 40.29 mcg/ml to 70.89 +/- 34.65 mcg/ml within 10 min. During extracorporeal circulation, elimination was as fast as before and after perfusion. 240 min after application, mean serum concentrations of 16.80 +/- 9.32 mcg/ml were measured. Failure of antibiotic prophylaxis in operations exceeding 4 h might be due to unadaequate antibiotic concentrations, beyond the minimal inhibitory concentration for the pathogens, reported to cause infections after cardiac operations.

Adult↗
PubMed1983

[A cosmetically advantageous approach to median sternotomy].

A horizontal submammary skin incision was chosen as approach route to median sternotomy in 36 patients undergoing cardiac operations. The low complication rate in conjunction with a cosmetically acceptable result makes this procedure the method of choice for selected patients. The potentially higher risk of infection should not be overlooked when planning the operation.

Adolescent↗
PubMedDate not supplied

Radiologic search for embolized leaflets of prosthetic heart valves: a report of two cases.

In a radiologic search for embolized leaflets of Edwards-Duromedics bileaflet valves in 2 patients, the embolized fragments were localized in the iliac vessels using computed tomography. Sonography was successful in one case and standard X-ray films of the abdomen were negative in both cases. In vitro investigations with Björk-Shiley and Edwards-Duromedics leaflets suggested that standard X-ray films of the abdomen and pelvis should be considered as the first investigational technique. If negative, computed tomography of the lower abdomen should be done.

Adult↗
PubMedDate not supplied

Domino transplantation of heart-lung and heart: an approach to overcome the scarcity of donor organs.

The scarcity of donor organs remains the main restricting factor for heart, heart-lung, and lung transplantation. Recently new techniques for separate harvesting of the heart and the lungs from one donor for two recipients have been developed. These techniques enable the optimal use of available grafts. Another approach to this problem is combined heart-lung transplantation for patients with end-stage lung disease but still adequate heart performance, and the subsequent transplantation of the recipient's heart into a second patient with end-stage heart disease. The main advantages of this procedure are its technical simplicity compared with double lung transplantation; the preservation of aortobronchial collaterals, resulting in improved blood supply to the trachea; and the possibility of transplanting a conditioned right heart well adapted to chronically elevated pulmonary pressure. We recently have performed this procedure with good clinical results and suggest it as the method of choice whenever two well-matched recipients are available.

Adolescent↗
PubMedDate not supplied

Four year follow-up of the Duromedics Edwards bileaflet valve prostheses.

The Duromedics Edwards (DE) bileaflet valve prosthesis was withdrawn from the market after 12 leaflet escapes had been reported in 20,000 implants. Effort is necessary to identify the failure mode to improve valve design or production, but the rate of other valve related complications will tell if it is worthwhile reintroducing this prosthesis. Five-hundred and sixty-four DE valves have been implanted in 508 patients between September 1983 and May 1988. Two-hundred and sixty-eight had aortic valve replacement (AVR), 183 mitral valve replacement (MVR) and 56 double valve replacement (DVR); the perioperative mortality was 6.9%. Follow-up has been 98.7% complete for a total of 1064 patient years and a mean follow-up of 26 months (range 3 to 54 months). Late mortality was 3.7%/yr and actuarial survival was 85 +/- 3% without and 78 +/- 3% including operative mortality after 54 months. Event free actuarial rates (linearized rates in parenthesis) were 93 +/- 2% (1.5%/yr) for thromboembolism, 91.7 +/- 1.9% (2.3%/yr) for anticoagulant related hemorrhage, 89 +/- 4.8% (2.3%/yr) for valve failure, 93 +/- 2% (1.8%/yr) for valve related mortality, 72 +/- 4.8% (6.3%/yr) for all valve related morbidity and mortality and 83 +/- 4.4% (3%/yr) for treatment failure. Two leaflet escapes occurred in the study group (0.18%/yr), both patients survived reoperation. The concept of reducing thrombus formation by a specially designed irrigating hinge mechanism was proven by a low rate of thromboembolism in our clinical follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMedDate not supplied

A new flush solution for extended lung preservation.

BACKGROUND: The aim of this study was to compare the effect of the most frequently used clinical preservation solution (Euro-Collins, group I) with a newly composed low potassium, glucose- and insulin-containing preservation solution (141 mmol/L sodium, 6.4 mmol/L potassium, 119 mmol/L chloride, 5 mmol/L magnesium, 10 gm/L glucose, 10 gm/L dextrane and 20 U/L insulin) (group II) on postischemic lung function. METHODS: We studied 12 isolated New Zealand White rabbit lungs in a closed circuit model during the first 4 hours of reperfusion after 24 hours of ischemic hypothermic storage. RESULTS: Oxygenation capacity, defined by the difference between the arterial and venous oxygen tension was significantly higher in group II compared with group I after 10 (58.7 +/- 5.8 versus 34.9 +/- 7.5 mm Hg), 30 (63.5 +/- 7.8 versus 27.3 +/- 10.4 mm Hg) and 180 minutes (77.7 +/- 7.2 versus 8.8 +/- 5.6 mm Hg). Ventilatory pressure was significantly lower in group II after 1 minute (11.3 +/- 1.3 mm Hg versus 13.7 +/- 0.5 mm Hg, p < 0.05), with no significant difference thereafter. No significant difference was found in pulmonary vascular resistance except after 20 minutes (30.8 +/- 1.2 dyns/cm5 [group I] versus 27.1 +/- 1.1 dyns/cm5 [group II], p < 0.05). CONCLUSION: These data suggest that this new solution provides superior lung function after 24 hours ischemic time compared with Euro-Collins solution.

Animals↗
PubMedDate not supplied

Redo lung transplantation: a North American-European experience.

An international survey of redo lung transplantation was performed to identify the morbidity and mortality rates and factors correlating with increased or decreased survival after this procedure. Twenty institutions in North America and Europe participated, and the study cohort included 61 patients who underwent 63 redo lung transplantation operations. Patients undergoing a redo heart-lung transplantation were excluded. The indications for reoperation included obliterative bronchiolitis (32 patients), graft failure (14 patients), intractable airway problems (8 patients), severe acute lung rejection (5 patients), and miscellaneous complications (4 patients). Five types of retransplantation procedures were performed, including redo ipsilateral single lung transplantation (24 patients), redo contralateral single lung transplantation (11 patients), single lung transplantation after double lung or heart-lung transplantation (13 patients), redo double lung transplantation (8 patients), and double lung transplantation after a previous single lung transplantation (7 patients). Actuarial survival was 65%, 49%, 42%, 35%, and 32% at 1, 3, 6, 12, and 24 months, respectively; survival was significantly (p < 0.05) worse than that of first-time lung transplant recipients recorded in the International Society for Heart and Lung Transplantation Registry. Actuarial survival did not differ according to the original diagnosis of the recipients, the indication for reoperation, or the type of retransplantation procedure performed. Similarly, recipient cytomegalovirus status and ventilator status before reoperation did not affect postoperative survival. Trends toward an improved outcome were noted in patients who were ambulatory before reoperation and in those receiving an ABO identical, as opposed to ABO compatible, graft at reoperation. Life table and step-wise logistic regression analysis identified donor cytomegalovirus status at reoperation to be an important determinant of outcome, with significantly (p < 0.05) improved survival in the donor cytomegalovirus-negative group. Polymicrobial infection was the most common cause of death at all time intervals after reoperation. The presence of disseminated infection and established multiorgan failure was almost uniformly associated with a fatal outcome. We conclude that redo lung transplantation may be indicated only in well-selected patients with obliterative bronchiolitis, severe airway complications, or graft failure. Donor cytomegalovirus status at reoperation is an important predictor of survival. The presence of disseminated infection and established multiorgan failure should be contraindications to lung retransplantation.

Adolescent↗